I'm a provider
You will be redirected to myBlue. Would you like to continue?
Please wait while you are redirected.
DESCRIPTIONTumor vaccines are a type of active immunotherapy that attempts to stimulate the patient’s own immune system to respond to tumor antigens. There are a number of different tumor vaccines for the treatment of malignant melanoma in various stages of development.
Vaccines using crude preparations of tumor material were first studied by Ehrlich over 100 years ago, but the first modern report suggesting benefit using these in cancer patients did not appear until 1967. Melanoma has been viewed as a particularly promising tumor for this type of treatment because of its immunologic features, which include the prognostic importance of lymphocytic infiltrate at the primary tumor site, the expression of a wide variety of antigens, and the occasional occurrence of spontaneous remissions. Melanoma vaccines can be generally categorized or prepared in the following ways:
At the present time, no melanoma vaccine has received approval from the FDA.
Related medical policy -
POLICYMelanoma vaccines are considered investigational.
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY2/2001: Approved by Medical Policy Advisory Committee (MPAC), ICD-9 diagnosis code 154.2-154.3, 172.0-172.9, 184.0-184.2, 184.4, 187.1, 187.4, 187.7, 187.9, 190.0-190.3, 190.5-190.6, 190.9 added
7/5/2001: Code Reference section updated, ICD-9 diagnosis code 197.5, 198.2, 198.4, 198.82, 230.5-230.6, 232.0-232.9, 233.3, 233.5-233.6, 234.0 added
7/12/2001: Hyperlinks added
2/14/2002: Investigational definition added
4/18/2002: Type of Service and Place of Service deleted
10/20/2004: Code Reference section updated, non-covered ICD-9 diagnosis code 154.2-154.3, 172.0-172.9, 184.0-184.2, 184.4, 187.1, 187.4, 187.7, 187.9, 190.0-190.3, 190.5-190.6, 190.9, 197.5, 198.2, 198.4, 198.82, 230.5-230.6, 232.0-232.9, 233.3, 233.5-233.6, 234.0 deleted
11/7/2005: Code Reference section updated; ICD-9 diagnosis code V58.12 added
7/10/2009: Policy reviewed, no changes
08/02/2011: Removed "Active Specific Immunotherapy with Therapeutic" from the policy title and statement.
11/06/2013: Policy description updated; no changes to policy statement. Deleted outdated references from the Sources section.
07/01/2014: Policy reviewed; no changes.
SOURCE(S)Blue Cross Blue Shield Association policy # 2.03.04
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.